NUR 414 Final Exam Questions with Complete Solutions A Grade

NUR 414 Final Exam Questions with Complete Solutions A Grade The physician orders Lactulose 30 mL by mouth per day for a client with cirrhosis. What finding below demonstrates the medication is working effectively? A. Improvement in level of consciousness B. Presence of asterixis C. Decreased albumin levels D. Absence of fruity breath - Answer-A. Improvement in level of consciousness A patient with cirrhosis may experience a complication called hepatic encephalopathy. This will cause the patient to become confused (they may enter into a coma), have pungent, musty smelling breath (fetor hepaticus), asterixis (involuntary flapping of the hands). This is due to the buildup of ammonia in the blood, which affects the brain. Lactulose can be prescribed to help decrease the ammonia levels. Therefore, if the medication is working properly to decrease the level of ammonia the patient would have improving mental status, decreased ammonia blood level, decreasing or absence of asterixis, and decreased ammonia blood level. Fruity breath is associated with DKA not hepatic encephalopathy. During the morning assessment of a client with cirrhosis, you note the client is disoriented to person and place. In addition, while assessing the upper extremities, the client's hands demonstrate a flapping motion. What lab result would explain these abnormal assessment findings? A. Ammonia level of 68 µ/dL B. Creatinine level of 2.9 mg/dL C. Potassium level of 3.7 mmol/L D. Calcium level of 10.9 mg/dL - Answer-A. Ammonia level of 68 µ/dL Based on the assessment findings and the fact the client has cirrhosis, the client is experiencing hepatic encephalopathy. This is due to the buildup of toxins in the blood, specifically ammonia. The flapping motion of the hands is called "asterixis". Therefore, an increased ammonia level would confirm these abnormal assessment findings (Normal ammonia: 10-80) A patient diagnosed with hepatitis develops splenomegaly. When reviewing the laboratory report, which of the following results will the healthcare provider anticipate? A. Polycythemia B. Leukocytosis C. Thrombocytopenia D. Neutrophilia - Answer-C. Thrombocytopenia The spleen acts as a reservoir for platelets. When the spleen is enlarged, as with splenomegaly, up to 90 percent of a person's thrombocytes can be sequestered within the enlarged spleen. A client diagnosed with viral hepatitis develops liver failure and hepatic encephalopathy. Which of these measures should the healthcare provider include in this client's plan of care? A. Provide high-protein feedings B. Monitor the blood glucose C. Institute droplet precautions D. Weigh once a week - Answer-B. Monitor the blood glucose Interventions for this patient include blood glucose monitoring (because of decreased glycogen synthesis and storage), monitoring PT and INR (because of decreased clotting factors), checking reflexes (because of the neurological effects of increased ammonia), providing diet/feedings that are low in protein (to decrease ammonia levels), and following standard precautions. The client should be weighed every day. A client with cirrhosis of the liver develops ascites, and the health care provider prescribes spironolactone. What should the nurse monitor the client for? A. Hyperkalemia B. Tachycardia C. Hypoglycemia D. Ecchymosis - Answer-A. Hyperkalemia